The goal of the present article is to describe the current advances and challenges in the clinical use of immediate implant placement protocols. The surgical management of the post-extraction socket at the time of tooth extraction includes the debridement of the socket and stabilization of the blood clot, bone grafting for alveolar ridge preservation or immediate implant placement. Immediate implant placement at the time of tooth extraction is a well-established primary treatment modality when adequate primary implant stability can be obtained in areas of an intact alveolus without buccal bone loss or soft tissue deficiency. Ideally, a bone-to-implant gap bigger than 2 mm should be present after ideal implant placement and this gap must be grafted with adequate bone substitute materials. Contemporary developments in digital diagnostic and planning tools, hard and soft tissue grafting, implant design and prosthetic approach have resulted in improved clinical outcomes, however, adequate case selection and surgical-restorative coordination are mandatory for optimal results.
The surgical options available for the management of the post-extraction socket at the time of tooth extraction include the debridement of the socket and stabilization of the blood clot for early or delayed implant placement, immediate implant placement and alveolar ridge preservation (Tonetti et al. 2019). Immediate, or type I (Hammerle et al. 2004; Gallucci et al. 2018) implant placement (IIP) is a viable and predictable (Morton et al. 2023) treatment modality where implant surgery is performed immediately following tooth extraction as part of the same procedure, as long as favorable anatomic conditions are present. This treatment modality should be carefully considered based on time gain, minimal invasiveness, and similar clinical outcomes in comparison with other available treatment approaches (Cosyn & Blanco 2023).
Immediate implant placement with immediate restoration (Figs 1 - 5) has been suggested as the contemporary primary treatment of choice (Tonetti et al. 2019; Levine at al. 2022; Morton et al. 2023; Cardaropoli et al. 2025) in areas of an intact alveolus with preserved buccal plate if proper primary implant stability can be achieved, a bone-to-implant gap bigger than 2 mm can be grafted (Cardaropoli et al. 2025), and no soft tissue deficiency is present. A flapless approach is preferred (Fig. 6) in order to avoid any remodeling of the outer bone surface due to bone resorption of the cortical bone after flap elevation (Nobuto et al. 2005) and potential misalignment of the mucogingival junction and reduction of keratinized tissue width (Engler-Hamm et al. 2011) due to coronal flap advancement to obtain primary closure.
Alveolar ridge preservation (Avila-Ortiz et al. 2019) and early implant placement with buccal contour augmentation (Buser et al. 2017) are also viable alternatives, depending on implant site characteristics such as available bone volume, the integrity of the buccal bone plate, and the periodontal phenotype (Tonetti et al. 2019; Cardaropoli et al. 2025). Case selection based on well-defined selection criteria is mandatory to guide the clinician in choosing the most appropriate approach to post-extraction site management (Buser et al. 2017; Cardaropoli et al. 2025).